It's clear that pain is understood
by anyone and that everyone feels it a bit differently. Overall, pain is an
unpleasant sensation that occurs in varying degrees of severity and is a
consequence of a number of processes. In order to manage pain, doctors discern
its intensity and frequency and the circumstance from which it springs.

Pain is typically categorized into
two broad areas: acute and
chronic. Acute pain is easier to
diagnose and treat than chronic pain. It usually occurs after an injury, and
people in this state look like they're in pain. This type of pain usually
disappears when the injury heals. If you break your nose in a fall or cut
yourself in your workroom, you probably feel the pain pulsing like a silent
alarm throughout your body. With acute pain, your heart rate, respiratory rate,
fight-or-flight response, and sweating increase. While acute pain is severe,
the good news is that it lasts a relatively short time.

Chronic pain is a lot more
complex.

A
Closer Look at Chronic Pain

An article on chronic pain in the
Journal of the American Medical
Association noted that chronic pain is expensive, mainly because of
the resulting disability and absence from work. In recent studies, researchers
say, "more attention has been paid to the impact of chronic pain on daily
living." And what an impact it has.

What is chronic pain? A typical definition says
that chronic pain is not one thing, but a condition that varies depending on
the person. The variables include where the pain is, what its cause is, and how
an injury heals. In some cases, the pain is simply inexplicable. However, one
description is consistently applicable: All chronic pain is long-term pain that
persists even after healing has occurred or when the condition that's causing
the pain does not go away. This is pain beyond what doctors expect to see from
a condition or injury that does clear up.

Some women with endometriosis have
worse symptoms during their cycles, while others begin feeling pain a week
before that. When these women describe their pain as chronic, it's because
they're uncomfortable for at least 2 weeks of the month. People who get bad
migraines usually experience them intermittently rather than every day. So in
that way, you may perceive your migraines as not actually being chronic, but
recurring. I also get migraines once a month, but I don't consider the
condition chronic. Healing starts here! Chronic pain cannot have power over
your thinking when you at least partly define it as something you will not
allow to affect how you function.

Unlike people in the throes of
acute pain, patients with chronic pain often do not appear to be in pain -- but
indeed they are! Research done with chronic pain sufferers shows that some
exhibit greater brain activity than healthy people when subjected to pain. This
may be why they experience pain more severely. Yet, they've gotten good at
"getting through" and soldiering on. Rather than seeing an elevated change in
vital signs, like increased heart rate, one usually sees vegetative signs, and,
not to be dismissed, such a person may appear depressed.

People with chronic pain tell me
that they have sleep disturbances, decreased libido, anhedonia (an inability to
feel pleasure), constipation, lethargy, and personality change; lose their
appetites; and sometimes are preoccupied with their bodies. These are all
classic symptoms of chronic pain. But why the pain? Often, it's due to a
disease, while at other times, it's the treatment of the disease that produces
the pain. When a person has any type of surgery, they can be left with a
long-term pain problem secondary to scarring, or even permanent nerve damage.

Chronic or persistent pain may
range from mild to severe, and it is present to some degree for long periods of
time. Some people with chronic pain that is controlled by medication can have
"breakthrough pain," which occurs when the medication does not work and
moderate to severe pain breaks through or is felt for a short time. This can
occur several times a day, even when the proper dose of medicine is given.

In treating chronic pain, it's
important to understand the different potential types and mechanisms of pain.

Referred pain is felt some
distance from where the pain actually originates. In other words, the site of
the pain is not necessarily the source. Osteoarthritis of the hip, for example,
causes pain to be experienced in the knee. In acupuncture, a form of Chinese
medicine, kidney problems can be indicated by pain in the knees.

Phantom pain occurs when
you have had a limb, breast, or other body part removed by surgery. People
describe the pain or unpleasant sensations as if they were coming from the
absent body part, but phantom pain is real and not in patients' minds.

Somatic pain is caused by
activation of a pain receptor. Remember, pain nerve endings, called
nociceptors, are programmed to respond to various stimuli, such as heat, cold,
and other physical sensations. The characteristics of the pain are very well
localized aching, throbbing, and a gnawing feeling. Examples include joint and
bone pain. This type of pain is generally very responsive to nonsteroidal
anti-inflammatory drugs (NSAIDS) like aspirin, and when they are no longer
helpful, one can use opiate medications to treat this type of pain.

Visceral pain is also
caused by activation of a pain receptor. The patient often feels achy, vaguely
localized pain. It commonly originates in the abdomen or the chest, it does not
feel as if it is limited to only one area. A good example of visceral pain is
chest pain due to a heart attack. In this case, the pain occurs in the chest,
but it can go up the neck and down the arm, too. This type of pain is a little
more difficult to treat, but it can respond to opiates and adjuvant
medications.

Neuropathic pain is caused by
destruction of a nerve in either the peripheral or central nervous system.
Neuropathy can be best thought of as a seizure of a nerve. People often
describe a severe, sharp, shooting, or stabbing pain or a burning, numb, or
tingling sensation.

Myofascial pain is muscle
pain that occurs in conjunction with other pains. The trigger point is a
localized, highly irritable spot in a taut band of skeletal muscle. Palpation
of these trigger points will alter the pain, causing it to increase or radiate.
You may feel as if you are having a muscle spasm.

AuthorsAnn Berger, MSN, MD, is one of the foremost
specialists in pain management in the nation. A medical oncologist specializing
in pain treatment, she has written and edited numerous books on pain and
palliative care for patients and health-care providers. Dr. Berger is also
senior editor of the most widely used textbook on palliative care, Principles and Practice of Palliative Care and
Supportive Oncology. She currently resides in Darnestown,
Maryland.

C. B. deSwaan is a New
York City-based freelance writer specializing in nonfiction. She has written 20
books with expert collaborators, including the best-selling Men Are Just Desserts and Smart Cookies Don't
Crumble.